Welcome! Blood, guts, trauma, surgery, and life saving intervention keep us on the adrenaline roller coaster of the ER. Of course, it's not always positive. The ER can be an emotionally taxing and sometimes heartbreaking workplace, and this blog serves as an outlet for the stress of making life and death decisions each and every day.

Sunday, March 30, 2014

I apologize for the long absence. I've transitioned into the life of a new parent, returned to work and am re-inspired to continue to share my crazy experiences at the animal ER.

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Last month, a client arrived at our clinic doors. With her was a visibly pregnant Irish Setter, who appeared bright and alert. Our clinic was busy, however the new client stepped right in front of another transaction, interrupting the receptionist, and started with her demands.

"I need a shot of PERTUSSIN, in a room, RIGHT NOW."

My receptionist, who was confused because this is not a medication (in fact, it is a made up word; similar to whooping cough 'pertussis,' but not a veterinary illness nor medication), asked the client to tell her what was going on with her pet so that we could help.

"I just need a shot of PERTUSSIN, RIGHT NOW. She's stalling out in labor and she needs the shot."

The receptionist asked her to please fill out the intake paperwork, and escorted her to an exam room where a technician would be in shortly to obtain vitals and a history.

I could overhear the conversation from the treatment area while working on another patient. Given my long history at the ER, I knew that the breeder/owner was asking for pitocin, the trade name for oxytocin, which is a medication utilized to induce or augment labor in both dogs and humans. She'd already displayed a bad attitude and being not-the-best-kind-of-breeder, she walked in to our clinic demanding medications, without a medical degree, or the knowledge to back up her demands.

Not even 30 seconds after being placed in the exam room, where I would be in to see her as soon as possible, she stormed out again, slamming the door. She again interrupted the receptionist, who was trying to go over instructions to check out another patient.

"Is someone going to be in here or what?" The client yelled. "She needs her pertussin, like, right now! Can't we just get her the shot and deal with the formalities later!!!???!!!" The receptionist kindly reminded her that the technician would be in momentarily, and that the paperwork is unfortunately a requirement for treatment (This isn't a novelty to veterinary medicine -- just like a human doctor's office, the dentist, a mechanic, or pretty much any other professional service, you have to give us your name, phone number and associated information, and sign a statement agreeing that you will pay your bill).

The receptionist tried to bring blankets and towels which would be needed for the expectant delivery, however, incredibly, the client threw them back at her, hissing, "We don't need your stupid towels!!"

As I continued to work on my patients in the treatment area, one of the technicians went to obtain vitals and a history on Susie, the Irish setter.

The client was increasingly agitated. She demanded to get 'the shot', without a doctor's exam, and without filling out the required information. The technician was forced to be firm -- she frankly told the client she could either fill out the paperwork and cooperate, or she could leave. The doctor will do an exam, and determine what treatments are recommended. You are not a veterinarian; you cannot prescribe medications. We want to help you. Let us do our job.

The client finally informed us that her dog, Susie, had delivered two puppies at home, but none for the last two hours. Contractions had ceased. This was Susie's third litter. She had a similar problem last breeding.

I entered, introduced myself, and started to examine Susie. She had many puppies remaining, easily palpable from the outside of her abdomen and on sterile vaginal exam, a wide open cervix. I could palpate a puppy at the tip of my finger. Susie was still having contractions and otherwise appeared in good health. As always, I made my medical recommendations based upon the most current information and what I believed was best and safest for my patient. I explained the risks of using pitocin without any testing, and why I did not recommend doing so; I explained the possible outcomes. The owner agreed to start with a few basic things, including checking electrolytes, performing an x-ray to make sure there was no puppies stuck, and from there we would determine if medications were the correct next step.

While we worked with Susie, she started to develop active labor as a result of manual stimulation. I was able to deliver another live puppy without any medications. I returned the puppy to the eager clients; I thought they would be excited and grateful, and happy that at this time no medications were need and labor was progressing normally. Instead the clients, who had since brought in three tubs worth of their possessions and set up camp in our exam room, were vile and angry.

"Don't you DARE come back in here," the client yelled. "Don't even think about bothering us. I'll tell YOU if there's a problem. You don't enter these doors without my permission. If Susie sees you you'll halt her labor and make things worse."

I was flabbergasted. Didn't you come to my hospital for help? Didn't I already help by getting her labor going? Wasn't the labor stalled at home and I got her labor re-started and delivered a puppy to you?

I tried to politely remind the clients that they were here for help, and it was my job to ensure the safety of my patients, which would necessitate checking on them once and awhile. The client would not relent. She yelled, she tried to intimidate me with her voice; she would not listen to reason. Exasperated with her attitude, I was forced to talk over her - and firmly stated - It is my job to ensure the safety of my patients. I will be checking on your dog when I feel it is required. I'm here to help you, and I hope you can understand that I cannot just leave you in here, alone, for hours on end." She did not understand. I closed the door and walked away as there was no point in continuing to debate this with her.

Several more puppies were delivered. The clients refused any assistance.

After about an hour, a car alarm started in our client lot. It did not belong to any staff members, and no other clients were in our building. After 5 minutes went by and the alarm continued, I cracked the door -

"I TOLD YOU NOT TO COME IN HERE!!!"

"I'm sorry to interrupt, but I wanted to let you know your car alarm is going off---"

"IT'S PROBABLY NOT EVEN OURS, IS IT A RED PICKUP?!"

"Yes. It is."

"Oh....."

They went to attend to their vehicle.

Another hour and a half passed with no news of puppies. I cracked the door, and quietly asked how things were going; and mentioned that a significant amount of time had passed and that it may be time to re-assess the situation.

"WE ARE FINE. WE HAVE THREE MORE PUPPIES. I TOLD YOU NOT TO COME IN UNLESS WE TELL YOU THERE IS A PROBLEM."

"Ma'am, that's just not going to happen. If you let us know when puppies are delivered, we will not interfere unless there is a problem. Stalling labor is a sign of a problem, and it's why you're here. I will not be bullied into not caring for my patient in an appropriate manner. If you do not want us to bother you, you are welcome to go home." I closed the door.

About 30 minutes later, the owner came out with a puppy in her hands, blood running down her arms.

"I cut the cord too short, and he's bleeding. I tried to hold pressure, but it's not working...."

I immediately took the puppy while a staff member escorted her back to her exam room. There was barely enough tissue left for me to ligate the badly hemorrhaging umbilical stump. I monitored the puppy and then returned it to the family.

I fail to understand why this client was so vicious and rude. She spent over 12 hours in our clinic, and we assisted with the delivery of 8 more puppies. We were prompt, kind, competent and efficient. We had nothing but Susie's best interest at heart; and the client never bothered to thank us for our help. Her adversarial attitude made this case much more difficult than necessary.

Practicing medicine and performing surgery are the easy parts of being a veterinarian. Dealing with horrible people like her is emotionally taxing and seemingly unnecessary.

All stories contained within this blog are inspired by my life as an emergency veterinarian. Details including but not limited to name, time of visit, species, and age are changed to protect the innocent and crazy alike. Any relationship to persons or animals, living or dead, is purely coincidental.

This isn't web DVM....

These stories are shared to inspire and to entertain. They are not intended to be medical advice. If your pet is sick, the only rational thing to do is have him or her seen (in real life) by a veterinarian.

Who is that masked woman, anyway?

Ever since I was little, I always had the dream of becoming a veterinarian. The dream has been realized, and my passion is emergency medicine. ER work has many pitfalls and disadvantages, but for me, the ability to be there in a moment of crisis and help both a beloved pet and their loving family, is worth the bad days.

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Definitions and commonly seen conditions

Anemia: Low PCV (see below). Anemia can result from external hemorrhage, internal hemorrhage, destruction of blood cells in the body, or inability to make new blood cells in the bone marrow.

Azotemia: Elevation in the BUN (blood urea nitrogen) or creatinine. BUN and creatinine are body wastes typically eliminated by the kidneys; increased levels in the body indicate kidney dysfunction, obstruction of urine, or severe dehydration.

Congestive Heart Failure (CHF): Accumulation of fluid in the lungs due to failure of the heart. Some symptoms include shortness of breath, decreased appetite, rapid breathing rates, coughing, and weakness.

Feline Lower Urinary Tract disease (also called feline idiopathic cystitis): A condition resulting in frequent, painful urination, and in the most severe cases, obstruction of the urethra. FLUTD has several potential causes and is also an extreme emergency.

GDV: Gastric dilatation and volvulus. Occurs in large breed dogs; the stomach fills with gas and twists. An extreme emergency, this condition is treated with stabilization and immediate surgery.

PCV: Packed cell volume. The percentage of red blood cells contained within a given sample of whole blood. Normal for dogs and cats is typically 35%-45%.